This application addresses broad Challenge Area (05): Comparative Effectiveness Research and specific Challenge Topic, 05-DA-104: Comparing Drug Treatment Effectiveness in Ethnic Minority Populations. Screening, Brief Intervention, and Referral to Treatment (SBIRT) is a comprehensive, integrated public health approach to identify and deliver a spectrum of early detection and treatment services for substance use in general medical care settings. The effectiveness of SBIRT has been demonstrated in numerous studies, and SBIRT is considered best practice by leading national medical associations for identifying and treating substance misuse even at early states. However, it is not known if SBIRT is effective for Latino/Hispanic populations, an important gap in knowledge given the large and growing numbers of Latinos, their relatively high drug use prevalence, and the disparities between Latinos and other ethnic/racial groups in terms of substance abuse treatment. This 2-year study will evaluate the effectiveness of SBIRT for drug use and related factors among 500 Latino and 500 non-Latino Whites visiting a large urban emergency department for various reasons. A randomized two-group repeated measures design will be used in which drug-related outcomes of an intervention group will be compared to those of an attention-placebo control group. Participants who report illicit drug use will be recruited from the waiting room of a large hospital Emergency Department, and randomly assigned to one of the two conditions. The intervention group ([unreadable]Life Shift[unreadable]) will receive SBIRT drug intervention matched to their risk level and drug of choice. To assess the [unreadable]true[unreadable] effect of the SBIRT intervention (I.e., minus the effects of attention), a control group will receive the same quantity of intervention in the area of driving safety ([unreadable]Shift Gears[unreadable]). Baseline and 6-month follow-up measures will be collected for all participants, and will include (a) standardized subjective drug use measures, (b) other measures presumed to be targeted by the intervention (e.g., functional status, perceived barriers to change), and (c) a biological sample tested for the presence or absence of multiple illicit drugs to increase the accuracy of subjective abstinence reports at the follow-up. In addition, driving safety control items will be collected to test the result of the experimental manipulation, with the attention-placebo control group expected to have greater pre-post change on these measures than the SBIRT intervention group. Latino/White differences in responses to the intervention will be the primary focus of the study. Generalized estimating equations (GEE) will be sued to test intervention-control group differences in follow-up abstinence rates, and whether experimental group differences hold for both Latinos and non-Latino Whites. Impact of the intervention on other outcomes including frequency and amount of drug use, functioning in life areas, subsequent health care utilization, and presumed intermediate variables targeted by the intervention will also be analyzed overall and by ethnic group. Process and implementation variables, (e.g., intervention coverage, observational quality measures, patient satisfaction) will be collected to measure fidelity of implementation, and to assess possible ethnic differences. This randomized control group study will be the first to establish if screening and brief intervention delivered in primary care settings during a [unreadable]teachable moment[unreadable] can motivate both Latino and non-Latino Whites to reduce drug involvement.